Patient age | Born to HCV infected mother | HCV antibodies | HCV RNA PCR | HCV RNA in liver or PBMCs* | Interpretation | Significance in paediatric patients |
---|---|---|---|---|---|---|
≤2 mo | Yes | Present | Not detected | Too early to interpret result because patient may not yet be viremic if transmission occurred at birth. | ||
2–17 mo | Yes | Present | Not detected | Vertical transmission of HCV did not occur, or the child has cleared HCV | Because the sensitivity of HCV RNA PCR may be <100%, antibodies should be tested at ≥18 months of age. If still present, HCV RNA PCR should be repeated to ensure HCV has been cleared. Children who clear HCV likely have no or very rare sequelae. | |
≥6 mo | Yes/No | Present | Detectable for >6 mo | Chronic HCV | Usually persists indefinitely in the absence of antiviral therapy, but spontaneous clearance likely more common in children than in adults. | |
≥18 mo | Yes/No | Present | Not detected | Small studies (15,16) in adults show virus almost always detectable in PBMCs and liver | Clearance of HCV† | Clearance occurs spontaneously with approximately 25% of acute HCV and an undetermined small percentage of chronic HCV, or occurs with successful antiviral therapy. |
Any age | Yes | Absent | No need to test | Vertical transmission of HCV did not occur, or the child has cleared HCV | Children who clear HCV likely have no or very rare sequelae. | |
Any age | Yes/No | Present | Detectable in a child <6 mo of age, or detectable <6 mo after a negative antibody or PCR test | Acute HCV | An estimated 75% will develop chronic HCV and 25% will clear HCV. | |
Any age | Yes/No | Absent | Present | Seronegative (immunosilent) HCV, or very early acute HCV (infection typically occurred 20 to 60 days prior) | Seronegative HCV mainly described in HIV coinfected adults and other immunosuppressed patients with the incidence in children not known. | |
Any age | Yes/No | Absent | Absent | Present | Occult HCV | Described in adults with unexplained elevated transaminase levels (18), with there being no paediatric studies. |